-Of those studies or articles which have captured qualitative data from people with self-harm difficulties surrounding communication and articulation of experiences in relation to their self-harm are often raised (Pembroke, 1994, Spandler, 2001, Horrocks, 2002, Adler and Adler, 2011). For example, both Spandler (2001) and Horrocks (2002) reported how participants described difficulties in finding the words to express reasons for their self-harm behaviour:
“I’ve been in casualty with my wrists slashed or I’ve taken an overdose and people ask me what’s the matter and I just can’t put it into words..”(Spandler, 2001)p.10
“there’s no words in the English language to describe it”(Horrocks, 2002)p.19
Suggestions as to why this might be have been discussed. For example, some suggest there is an absence of those opportunities which encourage expression of emotional distress in the context of self-harm (Pembroke, 1994). Other suggestions relate to language ability and the assumption that we can all easily use emotional language and articulate our distress effectively in spite of evidence that suggests different
psychological disorders affect speech and language (Adshead, 2010). Alexithymia
“literally translated is an absence of words for emotion” (Tacon, 2001) is just one example of a language disorder which has been associated with self-harm (Jones, 2004, Zlotnick et al., 1996).
Moreover, some of the developmental literature states how children of nursery school age (age 3) often have the beginnings of an emotional lexicon to describe their own experience and that of others, further development is said to take place over many years and involves the ability to use representation such as metaphor (Adshead, 2010).
Interestingly, children whose emotional lexicon is not yet developed often use the body as a metaphor for emotional distress, which Adshead (2010) suggests might illustrate how the body is the default setting for the expression of distress in the absence of an emotional vocabulary.
Somewhat related, self-harm has been described as an embodied experience, an experience which is felt and has affective dimensions, and as Cromby (2011) points
out, several researchers, particularly those seeking to capture ‘meaning’, assume affective dimensions of experience can be captured through language. Cromby (2011) argued that this is not always possible for two reasons at least. Firstly, emotions and feelings are not always obvious to those experiencing them and so they will not necessarily be disclosed verbally, and secondly, affect is often described as ineffable, something which is not always amenable to verbal description. Which would resonate with earlier discussions and the excerpts found in the studies carried out by Spandler (2001) and Horrocks (2002).
This might also explain why some of the studies discussed in Chapter 2 have shown how participants, when asked to spontaneously report why they harmed themselves, were more likely to refer to precipitating events / states (Michel et al., 1994, Rodham et al., 2004, Bancroft et al., 1979). For example, ‘I had an argument with my sister’
(Rodham et al., 2004 p.83) and work / relationship problems (Michel et al., 1994 p.174). It is possible that precipitating events, as opposed to reasons for their behaviour which might require more affect laden language, are easier to articulate.
This evidence highlights the potential limitations of employing methods which are reliant and based on the assumption that people are able to report verbally their reasons for self-harm. As the systematic review has shown, research questions such as these have typically been pursued with methods such as an interview or
questionnaire, yet arguably, both of these methods do not account for the difficulties people might experience when questioned about their reasons for their behaviour. For example, using a structured / measured approach might be viewed as problematic in that it restricts what people can report and our understanding of it. Relying solely on participants to offer a verbal account may also prove difficult; people who self-harm may need help to express themselves (Adshead, 2010). Some functions may be easier to verbalise and discuss than others. For example, some reported functions are considered more conceptual than others and may be more difficult to articulate. Some functions are considered less socially desirable such as those relating to influence of others, or perhaps embarrassing, such as those relating to sexual reasons which might impact on a participants willingness to disclose and discuss.
Finally, a need to feel in control has also been shown to be an underlying factor for many people who self-harm (Spandler, 2001, Warner and Spandler, 2012). Engaging in research can sometimes produce a fear of losing their sense of control and power of their own, often secretive, behaviour. This can result in a reluctance to engage and increase their need to self-harm (Spandler, 2001). This is not only an important consideration when designing research and thinking about ways of engaging people,
referred to the issue of recruiting people who may feel disempowered through illness in their study of women experiencing chemotherapy, they discussed how contextual factors were a key consideration in the design and execution of research.
3.1.1.2 Facilitators
“the best way to help people who self-harm is to allow them to express their feelings, and allow them to feel in control” (Pembroke, 1994 pg.23)
To counteract some of the fear of losing control through engaging in research Spandler (2001) suggested giving ownership of the research process to the people who self-harm as an effective way of working. This suggestion, along with enabling expression that does not rely on a purely verbal or restricted written account, might seem challenging in view of the conventional repertoire of methods available.
However, if we consider the suggestions of Latham (2003) and Spandler (2001) and adopt a more participatory and creative approach to our research design, this might enable more flexible and pragmatic thinking. In doing so we might start to consider more innovative and helpful ways of approaching such a sensitive and evidently challenging research question, ways perhaps that are more conducive to enabling people to express their experience of self-harm, and more contextually considerate and aligned with their experience. Essentially, a research design that will enable a different form of expression and give participants control could prove useful.
The value of adopting a visual approach with people who find it difficult to express themselves verbally has been well documented (Pink, 2001, Sweetman, 2009, Bagnoli, 2009, White et al., 2010, Erdner, 2010, Whitehurst, 2006). Moreover, research into other sensitive subject areas such as cancer (Frith and Harcourt, 2007, Radley and Taylor, 2003a, Radley and Taylor, 2003b) and mental health (Erdner, 2010) have also reported the benefits of adopting a visual approach.
More specifically, using visual material within the research process to represent experiences is said to be particularly useful in triggering the affective nature of experiences (Collier 1957, cited in Harper, 2002, Radley and Taylor, 2003b). Using a visual method as a tool / facilitator for expression might then prove useful in enabling participants to capture and verbalise their affective and embodied experiences of self-harm. Furthermore, other recent evidence has shown that people draw upon visual images during times of psychological distress (Holmes et al., 2005, Hales et al., 2011, Holmes et al., 2007). Holmes et al (2007) and Hales et al (2011) both showed how
participants, during times of psychological distress, were more likely to describe their experiences in the form of imagery (both distressing and comforting images) than verbal thoughts, suggesting that not only is visual imagery a new and promising avenue to explore in terms of its clinical utility, but perhaps it is also useful to researchers in that it might be relevant to and aligned with the experiences of those who self-harm.